AAP: Any Alcohol Exposure in Pregnancy Is Risky for Baby

Impact of fetal alcohol syndrome felt from conception through adolescence

Action Points

Prenatal alcohol exposure (PAE) is the leading preventable cause of birth defects and intellectual and neurodevelopmental disabilities, and the resulting neurocognitive and behavioral problems are lifelong.

Fetal alcohol spectrum disorder (FASD) is the general term encompassing the range of adverse effects associated with PAE; the diagnostic criteria for fetal alcohol syndrome (FAS) are specific.

Because children exposed to any amount of alcohol during pregnancy are at risk for fetal alcohol spectrum disorders (FASD), the American Academy of Pediatrics reaffirmed its recommendation that no amount of alcohol is safe during pregnancy.

In their latest clinical report published in Pediatrics, the AAP reiterated that any exposure to alcohol during pregnancy increases a child's risk of FASD, ranging from alcohol-related neurodevelopmental disorder (ARND) to more severe alcohol-related birth defects (ARBD).

ARBD presents with definite "diagnostic facial features." The so-called diagnostic triad includes small eyes, a smooth philtrum, and a thin upper lip.

But co-author Janet F. Williams, MD, FAAP, of the AAP Committee on Substance Abuse, told MedPage Today via email that clinicians need to be particularly watchful for the types of FASD that do not manifest physically.

"FASDs are quite prevalent yet under-suspected and under-diagnosed, so pediatricians should consider the diagnosis whenever there is developmental delay, intellectual disability, or neuropsychological and behavioral difficulties," she said. "FASD does not have a cure, but early recognition and intervention has the best chance of ameliorating FASD-related effects and improving medical, psychological and vocational outcomes."

Any other prenatal alcohol exposure (PAE)-related condition lacking the FAS facial phenotype is more difficult to diagnose, but the authors note there are certain indicators of PAE for which clinicians should be aware.

"A confirmed history of PAE should also prompt careful developmental screening and assessment for ARND/ND-PAE [neurobehavioral disorder associated with PAE], which is among the possible diagnoses when there are no physical stigmata of FAS, yet evidence of brain abnormalities and either structural or functional neurocognitive disabilities as problems with neurodevelopment, behavior, adaptive skills, and/or self-regulation," they wrote.

Williams added that even if clinicians are unable to detect any effects of alcohol exposure in a child exposed with PAE, that may only mean the detection method was not sufficiently sensitive to find subtle changes that actually did occur.

"There are very likely effects from prenatal alcohol exposure that are more subtle than methods are currently able to detect, so that as more sensitive detection methods are available in the future, detection will also improve," she said.

Indeed, the impact of PAE can extend from conception through adolescence. Exposure to alcohol can impact fetal development in the earliest stages of pregnancy. Binge drinking (defined as five or more standard drinks within 2 hours) is particularly dangerous, especially as it can occur before a woman realizes she is pregnant.

"Some of the more recent research has been interpreted to suggest that a low level alcohol use might be safe during pregnancy," Williams concluded. "The AAP wanted to educate the public that it did not endorse this interpretation and that the preponderance of the evidence shows the contrary."

Williams and colleagues disclose no relevant relationships with industry.

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